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Acid peptic diseases (view source)
Revision as of 07:41, 30 September 2021
, 07:41, 30 September 2021no edit summary
|title=Acid peptic diseases
|title=Acid peptic diseases
|titlemode=append
|titlemode=append
|keywords= Principles, diagnosis, management, acid peptic diseases,amlapitta, peptic ulcer, gastritis,parinama shoola, Inflammatory Bowel Diseases, Irritable Bowel Syndrome, Ayurveda, treatment interventions, medical system healthcare, symbiohealth, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease
|keywords= Principles, diagnosis, management, acid peptic diseases, gut health, amlapitta, peptic ulcer, gastritis, parinama shoola, Inflammatory Bowel Diseases, Irritable Bowel Syndrome, Ayurveda, treatment interventions, medical system healthcare, symbiohealth, charak samhita, caraka samhita, Indian system of medicine, pathogenesis of disease
|description= Principles of diagnosis and management of acid peptic diseases in Ayurveda are described.
|description= Principles of diagnosis and management of acid peptic diseases in Ayurveda are described.
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg
|label1 = Section/Chapter/topic
|label1 = Section/Chapter/topic
|data1 = Concepts and Contemporary Practices-[[Nidana]] [[Chikitsa]] / [[Vyadhi]] / Acid peptic diseases
|data1 = [[Concepts and Contemporary Practices]] -[[Nidana]] [[Chikitsa]] / [[Vyadhi]] / Acid peptic diseases
|label2 = Authors
|label2 = Author
|data2 = Prof. Dr. H.M. Chandola.<sup>1</sup>
|data2 = Prof. Dr. H.M. Chandola<sup>1</sup>
|label3 = Reviewer
|label3 = Reviewer
|data3 = Basisht G.<sup>2</sup>
|data3 = Basisht G.<sup>2</sup>
|label4 = Editor
|label4 = Editors
|data4 = Deole Y.S.<sup>2</sup>, Anagha.S.<sup>2</sup>,Basisht G. <sup>2</sup>
|data4 = Deole Y.S.<sup>2</sup>, Anagha.S.<sup>2</sup>,Basisht G. <sup>2</sup>
|label5 = Affiliations
|label5 = Affiliations
|data5 = <sup>1</sup>Former Dean I.P.G.T& R.A, Jamnagar & Director-Principal, C.B.P.A.C.S., Delhi, India
|data5 = <sup>1</sup>Former Dean I.P.G.T. & R.A, Jamnagar & Director-Principal, C.B.P.A.C.S., Delhi, India
<sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.T.& R.A., Jamnagar, Gujarat, India
<sup>2</sup>[[Charak Samhita Research, Training and Development Centre]], I.T.& R.A., Jamnagar, Gujarat, India
|data8 = Under process
|data8 = Under process
}}
}}
<big>'''Principles of Diagnosis and Management of acid peptic diseases in Ayurveda'''</big>
<div style = "text-align:justify;">
'''<big>Principles of diagnosis and management of acid peptic diseases in Ayurveda</big>'''
This article is based on the lecture delivered by Prof. H.M. Chandola, as part of Prof. M.S. Baghel Memorial Lecture Series on 09th April 2021.
<div style="text-align:justify;">
This article is based on the lecture delivered by Prof. H.M. Chandola, as part of Prof. M.S. Baghel Memorial Lecture Series on 09<sup>th</sup> April 2021.The video lecture can be accessed on the link of [https://fb.watch/8l8TUYT2eZ/ facebook page.]
==Introduction==
==Introduction==
In the present era, the world is changing focus on “preservation of health” rather than treating the diseases. New diseases are emerging day by day in new forms. It is high time to recognize the importance of boosting up the defense mechanism of the body. This helps to resist any kind of adverse circumstances and maintain the proper balance of all the components of health.
In the present era, the world is changing focus on “preservation of health” rather than treating the diseases. New diseases are emerging day by day in new forms. It is high time to recognize the importance of boosting up the defense mechanism of the body. This helps to resist any kind of adverse circumstances and maintain the proper balance of all the components of health.
Acharya Sushruta’s definition of a “healthy person” (swastha) is the most widely accepted one in [[Ayurveda]].[Su. Sa. Sutra Sthana 15/41]
Acharya Sushruta’s definition of a “healthy person” (swastha) is the most widely accepted one in [[Ayurveda]].[Su. Sa. Sutra Sthana 15/41]
The physical components of health are listed as the three [[dosha]] - ([[vata]], [[pitta]] and [[kapha]]); the seven body tissues ([[dhatu]]); and the excretory functions([[mala]]). Digestive power([[agni]] is also added with due importance. It indicates that all kinds of “transformation processes”, essential for the maintenance of health are facilitated by the [[agni]] from gross to minute level.
The physical components of health are listed as the three [[dosha]] - ([[vata]], [[pitta]] and [[kapha]]); the seven body tissues ([[dhatu]]); and the excretory functions([[mala]]). Digestive power ([[agni]]) is also added with due importance. It indicates that all kinds of “transformation processes”, essential for the maintenance of health are facilitated by the [[agni]] from gross to minute level.
Apart from physical health, the pleasant state and harmony of sensual faculties ([[indriya]]), mind ([[manas]]) as well as spiritual awareness ([[atma]]) are also the essential criteria for health. All these components are interrelated and can affect each other's state of well-being.
Apart from physical health, the pleasant state and harmony of sensual faculties ([[indriya]]), mind ([[manas]]) as well as spiritual awareness ([[atma]]) are also the essential criteria for health. All these components are interrelated and can affect each other's state of well-being.
E.g: mental disturbances or negative emotions can disturb the proper function of digestive power and vice versa. If a person is worried, sad, angry, or emotionally upset, even the wholesome food consumed in proper quantity will not get digested properly.[Cha. Sa.[[Vimana Sthana]] 2/9]
E.g: mental disturbances or negative emotions can disturb the proper function of digestive power and vice versa. If a person is worried, sad, angry, or emotionally upset, even the wholesome food consumed in proper quantity will not get digested properly.[Cha. Sa.[[Vimana Sthana]] 2/9]
== Good health begins in the gut==
== Three categories of [[agni]] ==
While explaining the concept of [[agni]], the main form of [[agni]] is called as the “jatharagni” (pachakagni) which refers to the digestive enzymes. There are five elemental enzymes (bhutagni) which are the micro-elemental converters, and also the seven corresponding tissue building enzymes (dhatwagni). The digestive enzymes (pachakagni) control the other two kinds of [[agni]] that are acting at the level of absorption and metabolism. The term “koshthagni” is used when it deals with the digestive process in the gastrointestinal tract (GIT).
Good health begins in the gut. While explaining the concept of [[agni]], the main form of [[agni]] is called as the “jatharagni” (pachakagni) which refers to the digestive enzymes. There are five elemental enzymes (bhutagni) which are the micro-elemental converters, and also the seven corresponding tissue building enzymes (dhatwagni). The digestive enzymes (pachakagni) control the other two kinds of [[agni]] that are acting at the level of absorption and metabolism. The term “koshthagni” is used when it deals with the digestive process in the gastrointestinal tract (GIT).
==Agni and patterns of digestion ==
When the [[agni]] is in the balanced state, it is known as “samagni”. But when it is affected by three [[dosha]], it shows three pathological variations. If there is an excess of [[kapha]] [[dosha]], it lowers the power of [[agni]] and the condition is known as “mandagni” (slow digestion). When [[pitta]] is in excess form, the [[agni]] becomes “teekshnagni” (fast/quick digestion). It can digest anything and everything and when the food is not available, it starts digesting the tissue elements ([[dhatu]]). For example, in thyrotoxicosis the hyperactivity of the thyroid gland causes high basic metabolic rate (BMR) and cachexia develops.
When the [[agni]] is in the balanced state, it is known as “samagni”. But when it is affected by three [[dosha]], it shows three pathological variations. If there is an excess of [[kapha]] [[dosha]], it lowers the power of [[agni]] and the condition is known as “mandagni” (slow digestion). When [[pitta]] is in excess form, the [[agni]] becomes “teekshnagni” (fast/quick digestion). It can digest anything and everything and when the food is not available, it starts digesting the tissue elements ([[dhatu]]). For example, in thyrotoxicosis the hyperactivity of the thyroid gland causes high basic metabolic rate (BMR) and cachexia develops.
When the [[agni]] is affected by vitiated [[vata]], it becomes “vishamagni” (irregular digestion). As [[vata]] has catalytic action (“yogavahi”), if it interacts with [[kapha]], it will enhance the activity of [[kapha]] and if it interacts with [[pitta]], it enhances the activities of [[pitta]].
When the [[agni]] is affected by vitiated [[vata]], it becomes “vishamagni” (irregular digestion). As [[vata]] has catalytic action (“yogavahi”), if it interacts with [[kapha]], it will enhance the activity of [[kapha]] and if it interacts with [[pitta]], it enhances the activities of [[pitta]].
==The concept of digestion in Ayurveda==
==The concept of digestion in Ayurveda==
The whole digestive process in the gut starts right from the mouth, where there is the action of “bodhaka [[kapha]]” to start the process of digestion. Then it goes to the stomach (amashaya) where it is subjected to the action of "kledaka [[kapha]]" for adding the moisture content (kleda) to the food material. Subsequently, from the stomach (amashaya) it goes into the portion of the small intestine called "grahani" which is the seat of "pachaka [[pitta]]". The 6th internal layer called "pittadhara kala" is also situated there. The main process of digestion occurs in this portion of the gut. It is followed by caecum (unduka) and large intestine (pakwashaya) where the separation of essence (sara) and excretory materials (kitta) occurs with the help of “samana [[vayu]]” which leads to the absorption and assimilation of nutrient portion and excretion of the waste products in the form of faeces ([[purisha]]) and urine ([[mutra]]) with the help of “apana [[vayu]]”.
The whole digestive process in the gut starts right from the mouth, where there is the action of “bodhaka [[kapha]]” to start the process of digestion. Then it goes to the stomach (amashaya) where it is subjected to the action of "kledaka [[kapha]]" for adding the moisture content (kleda) to the food material. Subsequently, from the stomach (amashaya) it goes into the portion of the small intestine called "grahani" which is the seat of "pachaka [[pitta]]". The 6th internal layer called "pittadhara kala" is also situated there. The main process of digestion occurs in this portion of the gut. It is followed by caecum (unduka) and large intestine (pakwashaya) where the separation of essence (sara) and excretory materials (kitta) occurs with the help of “samana [[vayu]]” which leads to the absorption and assimilation of nutrient portion and excretion of the waste products in the form of faeces ([[purisha]]) and urine ([[mutra]]) with the help of “apana [[vayu]]”.
The action of kledaka [[kapha]] is also executed by the following secretions in the gut.
The action of kledaka [[kapha]] is also executed by the following secretions in the gut.
*Serous & mucous secretions of salivary glands & oesophagus.
*Serous & mucous secretions of salivary glands & esophagus.
*Mucous secreted by mucous glands of surface mucous cells and mucous neck cells of the stomach.
*Mucous secreted by mucous glands of surface mucous cells and mucous neck cells of the stomach.
The action of "samana [[vayu]]" can be partially understood by the regulation of the secretion of HCL by parietal cells. The activities of the vagus nerve, the amount of gastrin from G cells and somatostatin from D cells, and the level of histamine play a vital role in this process.
The action of "samana [[vayu]]" can be partially understood by the regulation of the secretion of HCL by parietal cells. The activities of the vagus nerve, the amount of gastrin from G cells and somatostatin from D cells, and the level of histamine play a vital role in this process.
==Acid-Peptic Diseases==
== Acid-Peptic Diseases ==
Acid peptic disorders include many conditions whose pathophysiology is directly related to the damage caused by acid and peptic activity of gastric secretions. It includes gastroesophageal reflux disease, peptic ulcer (gastric and duodenal), and stress-related mucosal injury. In all these conditions, mucosal erosions or ulcerations arise when the caustic effects of aggressive factors overwhelm the defensive factors of the gastrointestinal mucosa.
Acid peptic disorders include many conditions whose pathophysiology is directly related to the damage caused by acid and peptic activity of gastric secretions. It includes gastroesophageal reflux disease, peptic ulcer (gastric and duodenal), and stress-related mucosal injury. In all these conditions, mucosal erosions or ulcerations arise when the caustic effects of aggressive factors overwhelm the defensive factors of the gastrointestinal mucosa.
==Aggressive and Defensive Factors==
==Aggressive and defensive Factors==
Here, the aggressive factors represent the acid, pepsin, bile salts, drugs (NSAIDs), and H. pylori and the defensive factors are represented by mucus, bicarbonate layer, proper blood flow, cell renewal prostaglandins, and phospholipids.
Here, the aggressive factors represent the acid, pepsin, bile salts, drugs (NSAIDs), and H. pylori and the defensive factors are represented by mucus, bicarbonate layer, proper blood flow, cell renewal prostaglandins, and phospholipids.
== Vitiation of Agni (Agni dushti) and Acid peptic disorders==
== Vitiation of Agni (Agni dushti) and Acid peptic disorders==
For maintaining health,[[agni]] should be in its balanced state, i.e. “samagni”. All other states of [[agni]] leads to acid peptic disorders.
For maintaining health,[[agni]] should be in its balanced state, i.e. “samagni”. All other states of [[agni]] leads to acid peptic disorders.
Improper dietary habits cause vitiation of [[agni]], which leads to the process of fermentation of food material and ultimately it forms the toxic material called “amavisha”. It leads to “indigestion” (ajeerna) by vitiating the [[dosha]]. Continuous indulgence in improper diet and erratic lifestyle aggravates [[pitta]] [[dosha]]. This leads to an acute condition of “vidagdhajirna”. This is converted into different acid-peptic disorders like gastritis, gastro-oesophageal reflux disease(amlapitta), duodenal ulcer (parinama shula), gastric ulcer(annadrava shula) etc.
Improper dietary habits cause vitiation of [[agni]], which leads to the process of fermentation of food material and ultimately it forms the toxic material called “amavisha”. It leads to “indigestion” (ajeerna) by vitiating the [[dosha]]. Continuous indulgence in improper diet and erratic lifestyle aggravates [[pitta]] [[dosha]]. This leads to an acute condition of “vidagdhajirna”. This is converted into different acid-peptic disorders like gastritis, gastro-oesophageal reflux disease(amlapitta), duodenal ulcer (parinama shula), gastric ulcer(annadrava shula) etc.
===Vidagdhajeerna and Amlapitta===
===Vidagdhajeerna and Amlapitta===
The clinical diagnosis of “vidagdhajeerna” is based on the symptoms like sour eructation, burning sensation, giddiness, thirst, and sweating.
The clinical diagnosis of “vidagdhajeerna” is based on the symptoms like sour eructation, burning sensation, giddiness, thirst, and sweating.
In case of “amlapitta”, the symptoms are indigestion, nausea, sour/bitter eructation, burning sensation in oesophagus, epigastric region, anorexia, and abdominal heaviness.
In case of “amlapitta”, the symptoms are indigestion, nausea, sour/bitter eructation, burning sensation in oesophagus, epigastric region, anorexia, and abdominal heaviness.
Many of the clinical researches on “amlapitta” had revealed that hyperacidity might not be an essential finding in all the patients with the symptoms of “amlapitta”. Many of them can be normosecretors. Some may be hyper secretors as in the case of “hyperchlorhydria” and some may even be hypo-secretors as in the case of hypochlorhydria.
Many of the clinical researches on “amlapitta” had revealed that hyperacidity might not be an essential finding in all the patients with the symptoms of “amlapitta”. Many of them can be normosecretors. Some may be hyper secretors as in the case of “hyperchlorhydria” and some may even be hypo-secretors as in the case of hypochlorhydria.
Here, mucosal resistance is very important. The abnormal acid medium erodes the mucous lining of the concerned segment of the gut leading to painful conditions of the upper abdomen like gastric ulcer (annadrava shula) and duodenal ulcer (parinama shula). So, where aggressive factors are dominant, like in hyper-secretors, it leads to duodenal ulcer (parinama shula). Where there is the weakness of defensive factors, like in hypo-secretors or normo-secretors, it leads to the gastric ulcer (annadrava shula).
Here, mucosal resistance is very important. The abnormal acid medium erodes the mucous lining of the concerned segment of the gut leading to painful conditions of the upper abdomen like gastric ulcer (annadrava shula) and duodenal ulcer (parinama shula). So, where aggressive factors are dominant, like in hyper-secretors, it leads to duodenal ulcer (parinama shula). Where there is the weakness of defensive factors, like in hypo-secretors or normo-secretors, it leads to the gastric ulcer (annadrava shula).
So, it is better to consider amlapitta as a syndrome (acid reflux syndrome) rather than a particular gastrointestinal disease. It closely resembles gastritis, non-ulcer dyspepsia, hyperchlorhydria as well as hypochlorhydria and in the chronic stage, it may lead to gastric ulcer.
So, it is better to consider amlapitta as a syndrome (acid reflux syndrome) rather than a particular gastrointestinal disease. It closely resembles gastritis, non-ulcer dyspepsia, hyperchlorhydria as well as hypochlorhydria and in the chronic stage, it may lead to gastric ulcer.
==Gastritis==
==Gastritis==
Gastritis is a clinical condition with upper abdominal discomfort like indigestion or dyspepsia in which specific clinical signs or radiological abnormalities are absent.
Gastritis is a clinical condition with upper abdominal discomfort like indigestion or dyspepsia in which specific clinical signs or radiological abnormalities are absent.
It is of two types- acute gastritis and chronic gastritis.
It is of two types- acute gastritis and chronic gastritis.
===Acute gastritis===
===Acute gastritis===
For acute gastritis, there are many causative factors including diet and personal habits like consumption of highly spiced food, excessive alcohol consumption, heavy smoking, infections like H. Pylori, viral hepatitis, drugs like NSAIDs, aspirin, chemotherapeutic agents, severe stress including emotional factors like anger, shock, resentment, trauma, surgery and excessive burn. Due to these stress factors and smoking habits, the tracheobronchial tree of the person becomes hypersensitive and there will be increased secretion of acetylcholine, catecholamines, and histamine. This leads to hypersecretion of HCL from parietal cells due to hyperstimulation of vagus and increased secretion of gastrin. It makes the person more prone to acid peptic disorders.
For acute gastritis, there are many causative factors including diet and personal habits like consumption of highly spiced food, excessive alcohol consumption, heavy smoking, infections like H. Pylori, viral hepatitis, drugs like NSAIDs, aspirin, chemotherapeutic agents, severe stress including emotional factors like anger, shock, resentment, trauma, surgery and excessive burn. Due to these stress factors and smoking habits, the tracheobronchial tree of the person becomes hypersensitive and there will be increased secretion of acetylcholine, catecholamines, and histamine. This leads to hypersecretion of HCL from parietal cells due to hyperstimulation of vagus and increased secretion of gastrin. It makes the person more prone to acid peptic disorders.
It is better to take advantage of recent technologies for finding out the exact cause of the condition. If the conventional Ayurvedic treatment is not giving the desired result, we should explore the other possibilities like H.pylori infection and treat accordingly.
It is better to take advantage of recent technologies for finding out the exact cause of the condition. If the conventional Ayurvedic treatment is not giving the desired result, we should explore the other possibilities like H.pylori infection and treat accordingly.
Principles of treatment in acute gastritis
====Principles of treatment in acute gastritis====
*The related organ, stomach (amashaya) should be given due importance. ( amashaya vishesha chikitsa)
*The related organ, stomach (amashaya) should be given due importance. ( amashaya vishesha chikitsa)
===Chronic gastritis===
===Chronic gastritis===
Recurrent attacks of acute gastritis may result in chronic gastritis.
Recurrent attacks of acute gastritis may result in chronic gastritis.
In its advanced stage, there is progression from chronic superficial gastritis to chronic atrophic gastritis characterized by mucosal atrophy and metaplasia of intestinal or pseudopyrloric type.
In its advanced stage, there is progression from chronic superficial gastritis to chronic atrophic gastritis characterized by mucosal atrophy and metaplasia of intestinal or pseudopyrloric type.
==== Principle of treatment of chronic gastritis ====
For treating the chronic gastritis, the principle of treatment of “[[vata]]-[[pitta]] dominant gulma” is recommended. It includes protecting the [[kapha]], which is the defensive factor. Here, the measures to reduce the penetrating power (tikshnatva) of [[pitta]] should be administered, followed by healing or soothing type of medicines (ropana chikitsa). The combination of Glycyrrhiza Glabra (madhuyashti), Asparagus racemosus (shatavari), Phyllanthus emblica (amalaki) with ghee and honey is best for healing action. Drugs with bitter (tikta) or sweet (madhura) tastes (rasa) are preferable here. Ghee or milk preparation processed with these kind of drugs are also advisable.
For treating the chronic gastritis, the principle of treatment of “[[vata]]-[[pitta]] dominant gulma” is recommended. It includes protecting the [[kapha]], which is the defensive factor. Here, the measures to reduce the penetrating power (tikshnatva) of [[pitta]] should be administered, followed by healing or soothing type of medicines (ropana chikitsa). The combination of Glycyrrhiza Glabra (yashtimadhu), Asparagus racemosus (shatavari), Phyllanthus emblica (amalaki) with ghee and honey is best for healing action. Drugs with bitter (tikta) or sweet (madhura) tastes (rasa) are preferable here. Ghee or milk preparation processed with these kind of drugs are also advisable.
The psychological component should also be addressed with equal importance because stress plays an important role in this condition. If a person’s mental status is not positive, it may lead to indigestion.
The psychological component should also be addressed with equal importance because stress plays an important role in this condition. If a person’s mental status is not positive, it may lead to indigestion.
Formulations like avipattikara churna, sitopaladi churna, yashtitriphala churna, dadimadi ghrita, shatavari ghrita, guduchyadi ghrita, ashwagandha mahatiktam ghritam are effective in this condition.
Formulations like avipattikara churna, sitopaladi churna, yashtitriphala churna, dadimadi ghrita, shatavari ghrita, guduchyadi ghrita, ashwagandha mahatiktam ghritam are effective in this condition.
== Gastro-esophageal reflux disease (GERD) ==
Due to decreased tone of lower oesophageal sphincter, the gastric contents get regurgitated frequently into the oesophagus. It causes damage to the mucous membrane of oesophagus and lead to esophagitis.The risk factors for this condition include obesity, fat-rich diet, caffeine, alcohol, smoking, and the symptoms are heartburn, regurgitation, and dysphagia. It can be diagnosed on the basis of clinical symptoms, 24 hour pH monitoring, endoscopy, and biopsy.
Due to decreased tone of lower oesophageal sphincter, the gastric contents get regurgitated frequently into the oesophagus. It causes damage to the mucous membrane of oesophagus and lead to esophagitis.The risk factors for this condition include obesity, fat-rich diet, caffeine, alcohol, smoking, and the symptoms are heartburn, regurgitation, and dysphagia. It can be diagnosed on the basis of clinical symptoms, 24 hour pH monitoring, endoscopy, and biopsy.
The main thing is the modification of dietary and personal habits. It is better to avoid hot and spicy foods, excessive use of pungent, sour, and salty food, fried items, curd, mustard, and sour fruits in the diet. It is recommended to avoid alcohol consumption, smoking, and regular intake of coffee.
The main thing is the modification of dietary and personal habits. It is better to avoid hot and spicy foods, excessive use of pungent, sour, and salty food, fried items, curd, mustard, and sour fruits in the diet. It is recommended to avoid alcohol consumption, smoking, and regular intake of coffee.
==Peptic ulcer==
== Peptic ulcer ==
It includes both gastric ulcer and duodenal ulcer formed due to the imbalance of aggressive factor and defensive factor as discussed earlier.
It includes both gastric ulcer and duodenal ulcer formed due to the imbalance of aggressive factor and defensive factor as discussed earlier.
Eating worsens the symptoms of gastric ulcer and improves the symptoms of duodenal ulcer. Hunger pain is observed in duodenal ulcer. The diagnosis is based on endoscopy. For detection of H. pylori, “rapid urease test” or “clo test” is performed. Biopsy is done to exclude possibility of cancer. In the management, high dose of proton pump inhibitors is given in conventional medicine.
Eating worsens the symptoms of gastric ulcer and improves the symptoms of duodenal ulcer. Hunger pain is observed in duodenal ulcer. The diagnosis is based on endoscopy. For detection of H. pylori, “rapid urease test” or “clo test” is performed. Biopsy is done to exclude possibility of cancer. In the management, high dose of proton pump inhibitors is given in conventional medicine.
===Gastric ulcer (annadrava shula)===
===Gastric ulcer (annadrava shula)===
In this condition, there is continuous severe pain not subsiding in any stages of digestion like after digestion or during digestion, whether at empty stomach or after taking food. It is relieved only after vomiting out the accumulated [[pitta]]. [M. Ni. Shula Nidana]
In this condition, there is continuous severe pain not subsiding in any stages of digestion like after digestion or during digestion, whether at empty stomach or after taking food. It is relieved only after vomiting out the accumulated [[pitta]]. [M. Ni. Shula Nidana]
===Duodenal Ulcer (Parinama shula)===
===Duodenal Ulcer (Parinama shula)===
[[Vata]] vitiated due to its causative factors, gets mixed and blocked by morbid [[pitta]] and [[kapha]]. It causes severe pain (shula), which is known as “parinama shula”.
[[Vata]] vitiated due to its causative factors, gets mixed and blocked by morbid [[pitta]] and [[kapha]]. It causes severe pain (shula), which is known as “parinama shula”.
In case of peptic ulcer, rice, bean, salt, sour food articles, and condiments should be avoided. Milk, banana, and coconut water are advisable.
In case of peptic ulcer, rice, bean, salt, sour food articles, and condiments should be avoided. Milk, banana, and coconut water are advisable.
=== Principles of treatment of peptic ulcer ===
As the first line of treatment, drugs having predominantly bitter taste (tikta rasa) and inducing dryness(ruksha) are used.
As the first line of treatment, drugs having predominantly bitter taste (tikta rasa) and inducing dryness(ruksha) are used.
In a research work on duodenal ulcer(parinama shula) by Antony Jose & H.M.Chandola(2004), a formulation called “Akshadi churna” [a combination of Terminalia chebula (haritaki) , Terminalia bellirica(bibhitaki) , Phyllanthus emblica (amalaki) and Piper longum(pippali)][ Chakradatta 27/6] along with ghee preparation called “medhya rasayana ghrita”[a combination of Convolvulus pluricaulis(shankhapushpi) , Centella asiatica(mandukaparni), Glycyrrhiza Glabra (yashtimadhu) and Tinospora cordifolia (guduchi) ] were used. It showed better results than administering only Akshadi churna. Significant difference was observed in the parameters of Brief Psychiatry Rating Scale. This shows the importance of dealing with the psychic component in this disease.
In a research work on duodenal ulcer(parinama shula) by Antony Jose & H.M.Chandola(2004), a formulation called “Akshadi churna” [a combination of Terminalia chebula (haritaki) , Terminalia bellirica(bibhitaki) , Phyllanthus emblica (amalaki) and Piper longum(pippali)][ Chakradatta 27/6] along with ghee preparation called “medhya rasayana ghrita”[a combination of Convolvulus pluricaulis(shankhapushpi) , Centella asiatica(mandukaparni), Glycyrrhiza Glabra (yashtimadhu) and Tinospora cordifolia (guduchi) ] were used. It showed better results than administering only Akshadi churna. Significant difference was observed in the parameters of Brief Psychiatry Rating Scale. This shows the importance of dealing with the psychic component in this disease.
==Inflammatory bowel Diseases (IBD)==
This includes two idiopathic bowel diseases having many similarities but distinctive morphological appearance.
This includes two idiopathic bowel diseases having many similarities but distinctive morphological appearance.
Symptoms like the elimination of faecal matter mixed with blood and mucous, having offensive smell are observed with weight loss in patients.These conditions are mentioned in the contexts of raktatisara, tridoshaja atisara and shokaja atisara. These symptoms are similar to IBD.
Symptoms like the elimination of faecal matter mixed with blood and mucous, having offensive smell are observed with weight loss in patients.These conditions are mentioned in the contexts of raktatisara, tridoshaja atisara and shokaja atisara. These symptoms are similar to IBD.
=== Principle of treatment for ulcerative colitis ===
The treatment protocols of “pittatisara” or “raktatisara”, “[[pitta]]-[[kapha]] grahani chikitsa”, “jirna pravahika chikitsa”, “adhoga raktapitta chikitsa” are adopted here. Anti-inflammatory (pakahara and shophahara) and anthelminthic (krimighna) treatments are preferred in cases of ulcerative colitis. Drugs having bitter (tikta) or sweet (madhura) taste, with healing (ropana) property, in the form of medicated milk are recommended here.
The treatment protocols of “pittatisara” or “raktatisara”, “[[pitta]]-[[kapha]] grahani chikitsa”, “jirna pravahika chikitsa”, “adhoga raktapitta chikitsa” are adopted here. Anti-inflammatory (pakahara and shophahara) and anthelminthic (krimighna) treatments are preferred in cases of ulcerative colitis. Drugs having bitter (tikta) or sweet (madhura) taste, with healing (ropana) property, in the form of medicated milk are recommended here.
In Ayurvedic parlance, it can be interpreted under the following clinical conditions.
In Ayurvedic parlance, it can be interpreted under the following clinical conditions.
a.Atisara [Cha. Sa. [[Chikitsa Sthana]] 19, Su. Sa. Uttara Tantra. 40 ]
a. Atisara [Cha. Sa. [[Chikitsa Sthana]] 19, Su. Sa. Uttara Tantra. 40 ]
b.Grahani [Cha. Sa. [[Chikitsa Sthana]].15, Su. Sa.Uttara Tantra 40, A. Hr. Nidana Sthana 8]
b. Grahani [Cha. Sa. [[Chikitsa Sthana]].15, Su. Sa.Uttara Tantra 40, A. Hr. Nidana Sthana 8]
c.Pravahika [Cha.Sa. [[Chikitsa Sthana]] 19]
c. Pravahika [Cha.Sa. [[Chikitsa Sthana]] 19]
d.Pakvashayagata vata [Cha. Sa. [[Chikitsa Sthana]] 28 /28-29]
d. Pakvashayagata vata [Cha. Sa. [[Chikitsa Sthana]] 28 /28-29]
Among these conditions, symptoms of [[vata]] predominant [[grahani]] show more resemblance with IBS. Poor digestion, hyperacidity, roughness in the body and flatulence during and after digestion are observed in this condition. The patient frequently passes stool with difficulty. The consistency of faecal matter is liquid mixed with hard stool, associated with sound and frothiness. [Cha. Sa. [[Chikitsa Sthana]]15/6-10]
Among these conditions, symptoms of [[vata]] predominant [[grahani]] show more resemblance with IBS. Poor digestion, hyperacidity, roughness in the body and flatulence during and after digestion are observed in this condition. The patient frequently passes stool with difficulty. The consistency of faecal matter is liquid mixed with hard stool, associated with sound and frothiness. [Cha. Sa. [[Chikitsa Sthana]]15/6-10]
Dietary modifications including more dietary fibers, psycho-social therapies, drugs like anticholinergics, antidepressants, antidiarrheals, anxiolytics and those acting on serotonin receptors are being used in the management of IBS. Probiotics have a greater role to enhance or support the bacterial flora in the gut.
Dietary modifications including more dietary fibers, psycho-social therapies, drugs like anticholinergics, antidepressants, antidiarrheals, anxiolytics and those acting on serotonin receptors are being used in the management of IBS. Probiotics have a greater role to enhance or support the bacterial flora in the gut.
=== Principles of treatment of IBS ===
The treatment principles of vataja grahani, atisara and pakwashayagata [[vata]] are used in the management of IBS. The psychological health component is taken care of by therapies like the pouring of liquid medicines like oil, medicated butter milk etc on the forehead (shirodhara/ takradhara) and anointment of medicated paste on scalp(shirolepa).
The treatment principles of vataja grahani, atisara and pakwashayagata [[vata]] are used in the management of IBS. The psychological health component is taken care of by therapies like the pouring of liquid medicines like oil, medicated butter milk etc on the forehead (shirodhara/ takradhara) and anointment of medicated paste on scalp(shirolepa).
Sitz bath with lukewarm medicated water(avagaha [[sweda]]), enema using medicated oil or ghee(anuvasana [[basti]]) are effective procedures in this condition.
Sitz bath with lukewarm medicated water(avagaha sweda), enema using medicated oil or ghee(anuvasana [[basti]]) are effective procedures in this condition.
The treatment principles can be divided into two as per the stages or phases:
The treatment principles can be divided into two as per the stages or phases:
The formulations like brihat gangadhara churna, dadimadi churna, hingvashtaka churna, jatilavangadi churna, kapitthashtakam churnam, chitrakadi vati, changeryadi gutika, manasa mitra vatakam, parushakadi lehya, kutajadi lehya, panchamrita parpati, kshara parpati, swarna parpati, with butter milk and medicated meat soups are also effective in this condition.
The formulations like brihat gangadhara churna, dadimadi churna, hingvashtaka churna, jatilavangadi churna, kapitthashtakam churnam, chitrakadi vati, changeryadi gutika, manasa mitra vatakam, parushakadi lehya, kutajadi lehya, panchamrita parpati, kshara parpati, swarna parpati, with butter milk and medicated meat soups are also effective in this condition.
The dietary items like wheat, maize, barley, peas, black gram, soya bean, kidney bean, potato, sweet potato, onion, ground nut, chilli, oily food, chicken, red meat, crabs, mango, pineapple, apple, watermelon, cashew, fig, pumpkin papaya and jackfruit shall be avoided by the patients of IBS.
The dietary items like wheat, maize, barley, peas, black gram, soya bean, kidney bean, potato, sweet potato, onion, ground nut, chilly, oily food, chicken, red meat, crabs, mango, pineapple, apple, watermelon, cashew, fig, pumpkin papaya and jackfruit shall be avoided by the patients of IBS.
The diet plan including the use of old rice, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, pomegranate, nutmeg buttermilk, and hot water are suitable.
The diet plan including the use of old rice, gourd, coriander leaves, lentil, green grams soup, black pepper, dried ginger, pomegranate, nutmeg buttermilk, and hot water are suitable.
In a clinical study on IBS, by Raksha Mer & H. M. Chandola (2004), the effect of kutajadi avaleha alone and kutajadi avaleha along with medhyarasayana ghrita was compared. Better results were observed in the combined group. This shows the importance of addressing the psychological component in the treatment protocol.
In a clinical study on IBS, by Raksha Mer & H. M. Chandola (2004), the effect of kutajadi avaleha alone and kutajadi avaleha along with medhyarasayana ghrita was compared. Better results were observed in the combined group. This shows the importance of addressing the psychological component in the treatment protocol.
==Butter milk - the best medicine for gut related disorders==
==== Butter milk - the best medicine for gut related disorders ====
Buttermilk has an astringent taste (kashaya rasa) and hot potency (ushna virya). It increases the digestive power ([[deepana]]) and absorbs fluid from the stool (grahi). It decreases aggravated [[kapha]] and rectifies the digestive process. It’s sweet and sour taste do not provoke [[vata]]. Its property of “madhura vipaka”, does not cause the aggravation of [[pitta]]. So, it is best to keep the balance of all the three [[dosha]] in gut.
Buttermilk has an astringent taste (kashaya rasa) and hot potency (ushna virya). It increases the digestive power ([[deepana]]) and absorbs fluid from the stool (grahi). It decreases aggravated [[kapha]] and rectifies the digestive process. It’s sweet and sour taste do not provoke [[vata]]. Its property of “madhura vipaka”, does not cause the aggravation of [[pitta]]. So, it is best to keep the balance of all the three [[dosha]] in gut.
Buttermilk contains all essential macronutrients. It has a cooling effect on the digestive tract. It encourages digestion and treats gut ailments. It is effective against dehydration. It provides calcium without fat and is rich in vitamins, like riboflavin.
Buttermilk contains all essential macronutrients. It has a cooling effect on the digestive tract. It encourages digestion and treats gut ailments. It is effective against dehydration. It provides calcium without fat and is rich in vitamins, like riboflavin.
== Rejuvenating ([[rasayana]]) drugs for gut health==
=== Rejuvenating ([[rasayana]]) drugs for gut health ===
Emblica officinalis (amalaki), Eclipta alba (bhringaraja) and Asparagus racemosus (shatavari) are recommended for the health of stomach.
Emblica officinalis (amalaki), Eclipta alba (bhringaraja) and Asparagus racemosus (shatavari) are recommended for the health of stomach.
==Summary and Conclusion==
==Summary and Conclusion==
*Ayurvedic diagnosis of Acid Peptic disorders mainly depends on etiological factors, clinical manifestation of disease (symptomatology), relieving factors (upashaya) and aggravating factors (anupashaya).
*Ayurvedic diagnosis of Acid Peptic disorders mainly depends on etiological factors, clinical manifestation of disease (symptomatology), relieving factors (upashaya) and aggravating factors (anupashaya).
*Ayurvedic management depends on the assessment of dominant symptoms, assessment of involved [[dosha]] (dysregulation of kledaka [[kapha]], pachaka [[pitta]] and samana [[vayu]]) and its dominant properties (amshansha Kalpana), status of [[agni]] and [[ama]].
*Ayurvedic management depends on the assessment of dominant symptoms, assessment of involved [[dosha]] (dysregulation of kledaka [[kapha]], pachaka [[pitta]] and samana [[vayu]]) and its dominant properties (amshansha Kalpana), status of [[agni]] and [[ama]].
*Drugs that correct [[ama]], optimize [[agni]], regulate samana [[vayu]], pacify aggravated pachaka [[pitta]], protect kledaka [[kapha]], aid digestion, promote smooth transit of food in the gut, integrate intestinal motility are most suitable to treat acid peptic disorders in [[Ayurveda]].
*Drugs that correct [[ama]], optimize [[agni]], regulate samana [[vayu]], pacify aggravated pachaka [[pitta]], protect kledaka [[kapha]], aid digestion, promote smooth transit of food in the gut, integrate intestinal motility are most suitable to treat acid peptic disorders in [[Ayurveda]].
*The principle of treatment includes that of Amlapitta, Annadrava shula, Parinama shula, Atisara & Grahani.
*The principle of treatment includes that of Amlapitta, Annadrava shula, Parinama shula, Atisara & Grahani.
*Modifications of diet, life style and stress management have greater role in their management.
*Modifications of diet, life style and stress management have greater role in their management.
*Integration of tradition and technology is the need of hour.
*Integration of tradition and technology is the need of hour.
In present scenario, ancient knowledge shall be enriched with recent updated diagnostic tools to achieve the goal of a healthy and happy life.
In present scenario, ancient knowledge shall be enriched with recent updated diagnostic tools to achieve the goal of a healthy and happy life.
==Interaction Session==
==Interaction Session==
Q: How to treat H.pylori infection through Ayurveda?
A. There is no specific Ayurvedic drug proven for its action on eradicating H.Pylori through any research works. We need to adopt the principles of treatment of krimi. Many single drugs like Holarrhena antidysenterica (kutaja), Butea monosperma (palasha), Embelia ribes (vidanga) etc. and formulations like krimimugdar rasa, krimikuthara rasa etc. have “krimighna” properties. If we make some combinations of these and try, it can have good results along with the amlapitta chikitsa.
'''Q:''' How to treat H.pylori infection through [[Ayurveda]]?
Q : Usually in acid-peptic diseases, asava- arista preparations are not prescribed. But in the management of ulcerative colitis you have mentioned some asava- arishta preparations. Can you elaborate the concept a little further?
A. There are lot of differences in preparation of asava -arishta in traditional method of fermentation and the one which is followed in current era. The readymade preparations available now a days can cause undesirable effects especially in the condition of acid peptic disorders. But if they are prepared in the traditional method, and used judiciously, it can give good results.
'''A.''' There is no specific Ayurvedic drug proven for its action on eradicating H.Pylori through any research works. We need to adopt the principles of the treatment of krimi. Many single drugs like Holarrhena antidysenterica (kutaja), Butea monosperma (palasha), Embelia ribes (vidanga) etc. and formulations like krimimugdar rasa, krimikuthara rasa etc. have “krimighna” properties. If we make some combinations of these and try, it can have good results along with the amlapitta chikitsa.
'''Q:''' Usually in acid-peptic diseases, asava- arista preparations are not prescribed. But in the management of ulcerative colitis you have mentioned some asava- arishta preparations. Can you elaborate on the concept a little further?
'''A.''' There are a lot of differences in preparation of asava -arishta in traditional method of fermentation and the one which is followed in the current era. The readymade preparations available nowadays can cause undesirable effects especially in the condition of acid peptic disorders. But if they are prepared in the traditional method, and used judiciously, it can give good results.
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